What is the significance of a faecal elastase-1 level between 200 and 500 mu g/g?

BackgroundPancreatic exocrine insufficiency is a cause of malabsorption. It is generally diagnosed if faecal elastase-1 (FE-1) levels are below 200 mu g/g. Pancreatic function is assumed to be normal when faecal elastase levels are >500 mu g/g. The significance of faecal elastase levels above 200 mu g/g but less than 500 mu g/g is unclear. MethodsThis retrospective study reports the response to treatment in patients who had an FE-1 level between 200 and 500 mu g/g. ResultsOf these 82 patients, 28 were offered pancreatic enzyme replacement therapy (PERT). A clinical response, defined as an improvement in their initial symptoms after commencing PERT, was seen in 20 patients (71%), 7 with potentially predisposing conditions and 13 with functional diarrhoea. PERT particularly abolished or improved diarrhoea, steatorrhoea and flatulence. ConclusionClinicians should, therefore, be aware that a trial of PERT given to patients with FE-1 levels between 200 and 500 mu g/g may lead to improvement in gastrointestinal symptoms.